An observational study of paracetamol (acetaminophen) deprescribing in patients with cancer pain receiving opioids for moderate-to-severe pain
Abstract
Background. The objective of the study was to investigate the utility of deprescribing paracetamol in cancer patients receiving opioids for moderate-to-severe pain.
Material and methods. Patients with well-controlled cancer pain (average pain intensity ≤ 4/10), who were receiving regular paracetamol and an opioid for moderate-to-severe pain, completed the Brief Pain Inventory — Short Form at baseline and at seven days post discontinuation of the paracetamol (or sooner if restarting the paracetamol). The study employed a Simon optimal two-stage design with the aim of reducing the number of subjects exposed to a “futile” intervention.
Results. Forty-four patients were enrolled, and 40 patients completed the study. Eighteen (45%) patients restarted the paracetamol, although another four patients reported a worsening of pain control and/or an increase in the use of rescue medication. The only factor associated with restarting paracetamol was the pathophysiology of the pain, with patients with mixed pain more likely to restart paracetamol than patients with nociceptive pain (P = 0.013).
Conclusions. On the basis of these results we would recommend a trial of discontinuing paracetamol in all patients receiving opioids for moderate-to-severe pain, who are deemed to be adequately pain controlled. The patients can be reassured that there is approximately a one in two chance of not needing to restart the paracetamol, and that if they do need to start the paracetamol, pain control can be re-gained within a very short period of time.
Keywords: paracetamolacetaminophendeprescribingcancer painanalgesicsopioid
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